QUEENS BENCH DIVISION
ADMINISTRATIVE COURT
Strand, London, WC2A 2LL |
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B e f o r e :
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THE QUEEN ON THE APPLICATION OF B |
Claimant |
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- and - |
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CORNWALL COUNTY COUNCIL - and - THE BRANDON TRUST |
Defendant Interested Party |
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WordWave International Limited
A Merrill Communications Company
190 Fleet Street, London EC4A 2AG
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Dr Nick Armstrong (instructed by County Legal Services) for the Defendant
Hearing date: 25 February 2009
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Crown Copyright ©
Mr Justice Hickinbottom
Introduction
Legal Framework and Guidance
"(1) Subject to sub-section (3) below, an authority providing a service to which this section applies may recover such charge (if any) for it as they consider reasonable.
(2) …
(3) If a person
(a) avails himself of a service to which this section applies, and
(b) satisfies the authority providing the service that his means are insufficient for it to be reasonably practicable for him to pay for the service the amount which he would otherwise be obliged to pay for it,
the authority shall not require him to pay more for it than it appears to them that it is reasonably practicable for him to pay …."
In short, an authority has a power (but not a duty) to levy a charge for services they provide, so long as the charge is reasonable and the service user has means to pay. It is common ground that the relevant services provided by the Authority to B fall within the provisions of Section 17.
"A local authority shall, in the exercise of their social services functions, including the exercise of any discretion conferred by any relevant enactment, act under the general guidance of the Secretary of State."
The Secretary of State has given guidance under this section in respect of charging policies for non-residential social services, to which I shall return (see paragraph 13 below). The obligation of an authority to "act under" guidance was described by Sedley LJ (as he then was) in R v Islington London Borough Council ex parte Rixon (1998) 1 CCLR 119 at page 123, as having the following effect:
"In my judgment Parliament in enacting Section 7(1) did not intend local authorities to whom ministerial guidance was given to be free, having considered it, to take it or leave it. Such a construction would put this kind of statutory guidance on a par with the many forms of non-statutory guidance issued by departments of state…. Parliament by Section 7(1) has required local authorities to follow the path charted by the Secretary of State's guidance, with liberty to deviate from it where the local authority judges on admissible grounds that there is good reason to do so, but with freedom to take a substantially different course."
That approach to such guidance was approved by the Court of Appeal in Lambeth London Borough Council v Ireneschild [2007] EWCA Civ 234.
"In relation to assessment of needs, Section 47 of the National Health Service and Community Care Act 1990 ("the 1990 Act") provides as follows:"
"(1) … [W]here it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority
(a) shall carry out an assessment of his needs for those services; and
(b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services.
(2) If at any time during the assessment of the needs of any person under sub-section (1)(a) above it appears to a local authority that he is a disabled person, the authority
(a) shall proceed to make such a decision as to the services he requires as mentioned in Section 4 of the Disabled Persons (Services, Consultation and Representation) Act 1986 without his requesting them to do so under that section; and
(b) shall inform him that they will be doing so and of his rights under that Act.
(3) …
(4) The Secretary of State may give directions as to the manner in which an assessment under this section is to be carried out or the form it is to take but … it shall be carried out in such manner and take such form as the local authority consider appropriate …."
"(1) In assessing the needs of a person under Section 47(1) of the Act a local authority must comply with Paragraphs (2) to (4).
(2) The local authority must consult the person, consider whether the person has any carers and, where they think it appropriate, consult those carers.
(3) The local authority must take all reasonable steps to reach agreement with the person and, where they think it appropriate, any carers of that person, on the Community Care Services which they are considering providing to him to meet his needs.
(4) The local authority must provide information to the person and, where they think it appropriate, any carers of that person, about the amount of the payment (if any) which the person will be liable to make in respect of the Community Care Services which they are considering providing to him."
These directions set a pattern for the general scheme of community care. Decision-making rests in the responsible authority, but their powers are only to be exercised after appropriate engagement with the service user and any relevant carers (who may include for example the service user's parents or other family). Prior to coming to a concluded view on needs, they should consult: prior to coming to a decision on steps to be taken to meet that need, they should attempt to reach agreement: and in relation to the on-cost to the service user, they should provide appropriate information.
"Once needs have been assessed, the services to be provided or arranged and the objectives of any intervention should be agreed in the form of a care plan."
And, at Paragraph 3.26:
"Decisions on service provision should include clear agreement about what is going to be done, by whom and when, with clearly identified points of access to each of the relevant agencies for the service user, carers and for the care manager."
That is reflected in the more recent policy guidance "Fair Access to Care" (HMSO, 2002) at Paragraph 47 which is guidance on the single assessment process directed at older people's care needs: but, as the learned authors say, it provides "a useful check list for the categories of information that [care] plans should contain" generally. That checklist includes an indication of whether the service user or relevant carers have agreed the care plan and, if not, why agreement was not possible.
"… far from marginalising the care plan, places it at the centre of any scrutiny of the local authority's due discharge of its functions. As Paragraph 3.24 of the [1990] policy guidance indicates, a care plan is the means by which the local authority assembles relevant information and applies it to the statutory ends, and hence affords good evidence to any inquirer of the due discharge of its statutory duties. It cannot, however, be quashed as if it were a self-implementing document"
Sedley J there identifies one important purpose of a care plan, namely the application of the statutory objectives to a particular case on the basis of the information the authority have gathered. It therefore comes as no surprise that the guidance as to content of the care plan in "Care Management and Assessment - A Practitioner's Guide" (HMSO, 1991) is that it should include not only objectives, but also the services to be provided and by whom, other options considered, the cost to the service user, any points of difference between the service user, carer, care planning practitioner and any agency, and any unmet needs. The care plan provides the link between objectives, through the identification of needs and services that are to be provided to satisfy or alleviate those needs, to the cost to the service user.
(i) Councils have power to charge for community care services. There is no duty to charge, or even any presumption that there will be charging.(ii) Where an authority does charge, they retain a substantial discretion in the design of the charging policy.
(iii) In setting any charge, the authority should have regard to the effect of any charge on a user's net income, which should not be reduced below the level of income support plus 25%. Disability benefits need not be taken into account as income at all. However, where they are taken into account as income in assessing the ability to pay a charge, an authority should assess disability-related expenditure ("DRE") which, with allowances, has to be set off against income to ascertain available income against which any charge may be levied. Assessment of DRE has to be done on an individual basis: "It is not acceptable to make a charge on disability benefits without assessing the reasonableness of doing so for each user". For this reason (and because users including relevant carers will very often need personal help and advice on how to claim), "Assessments involving [DRE] should … normally be carried out by personal interview in the user's own home" (Paragraph 45). It is understandably stressed throughout the guidance that the fact that assessment of needs, the appropriate steps to fulfil those needs and what might be DRE are all matters quintessentially individual to a specific service user.
(iv) Charging policies should be demonstrably fair as between different service users.
(v) Authorities need to ensure that: "The overall objectives of social care, to promote the independence and social inclusion of service users, are not undermined by poorly designed charging policies" (Paragraph 3). "The approach should support self-assessment by the user as much as possible, taking a holistic view of the user's finances and personal needs, both to support the user's own independence of living and to ensure that any charge assessed is reasonable" (Paragraph 45). Therefore, whilst decisions as to what might be a care need, and the services that might be provided to meet that need, are for the responsible authority, the service user's own assessment is an important factor to be taken into account. Again, this highlights the requirement for engagement between the authority and the service user and any carers.
(vi) The user's care plan will normally be a guide to what is necessary for care and support, although some discretion may be needed. Given that the care plan is intended to set out the service user's community care needs and how they are to be addressed, that is clearly a good starting point.
(vii) Given that it is impossible to give a comprehensive list of DRE, authorities have to develop local policies consistent with the statutory guidance. "The overall aim should be to allow for reasonable expenditure needed for independent living by the disabled person. Items where the user has little or no choice other than to incur the expenditure, in order to maintain independence of life, should normally be allowed" (Paragraph 44). That is a matter to which I shall return.
(viii) The authority may request evidence of actual expenditure, to verify that items claimed for have actually been purchased (Paragraph 50).
(ix) "The Government expects all Councils to explain how these issues will be addressed as part of consultation with users and carers on their charging policies." (Paragraph 80(xi)). The importance of consultation with users and carers about charging policies and increases or changes in charges is stressed as "one of the main principles" (Paragraph 98). "Where changes in charging policies would result in significant increases in charge for some users, this should be specifically explained and considered as part of a consultation" (Paragraph 99).
(x) The importance of authorities getting key processes right is stressed, if the development of policies is to be well-informed and local users are to understand and accept charging policies (Paragraph 94). Clear information about charging and how they are assessed should be readily available for users and carers (Paragraph 95). And, once a person's care needs have been assessed and a decision has been made about the care to be provided, assessment of ability to pay should be made promptly and written information about the charges and how they have been calculated should be communicated promptly (Paragraph 96).
(xii) Finally, the information for those liable for charges should make clear that they make seek a review of the assessed charge, or make a formal complaint if they are dissatisfied with any aspect of the assessment (Paragraph 102).
"Make a note if evidence is unavailable and ask the service user to provide it at the next review."
In respect of reasonable DRE, under the heading "Private Care", it is said:
"In all cases the Case Coordinator or Social Worker must be asked to confirm whether privately arranged care results from an assessed care need, and evidence of their agreement kept on file…
If a friend/relative provides private care, the minimum wage can be used as a maximum benchmark to ensure the amount being paid to them is reasonable."
In relation to day care, the authority of a Senior Finance Officer or Senior Administrative Officer is needed to agree anything exceeding "1 day/week privately funded by the service user." Alternative health costs (physiotherapy, reflexology, vitamins etc) "will only be allowed in exceptional circumstances if the service user's GP confirms the need for it." There is no reference at all to holiday costs.
Factual Background
"… [M]oney provided by the [Authority] is subject to financial assessment (very roughly people receiving benefits would not have to make a financial contribution). This is complex and Jean [Pippard, Commissioning and Partnership Officer, Department of Adult Social Care, Cornwall County Council ("DASC")] will invite a person from the Domiciliary Care Charging Unit to attend the next meeting to explain how this works."
"… gave an overview of the [DASC] Charging Policy. Individuals will be individually assessed if they are in receipt of funding from DASC, and benefits will be maximised where appropriate. Sue left her card with representatives at the meeting and welcomed direct contact from individuals if they wished any further discussion [of] any of the points raised."
Mr & Mrs B were at that meeting, at which Ms Colliver was put forward by the Authority as a senior person able to explain the "complex" charging position: as something of an "expert".
"So, while we realised that charging was something that happened to some people, for instance people who do not receive welfare benefits, there was never a suggestion that it could be a reality for [B]".
Looking at all of the evidence (including later letters), I have no doubt that that was the genuine understanding of Mr and Mrs B, nor do the Authority suggest otherwise.
B's Care Plans
"[B] could not live his life safely and meaningfully without support throughout the day. At times he also needs someone to be awake during the night should his sleep be disturbed by his excitement."
There was also an indication that Mr & Mrs B "would like him to have more access to activities outside his house, anything to stop him from being bored….". Because of his need for routine, it was recognised that this would not be easy to accommodate:
"It may be possible for him to consider activities which start later in the day. [B] is able to undertake activities which could be built upon such as housework, chopping wood and managing the recycling. A further assessment of skills and potential may be advantageous to [B]. Individual support to [B] is vital for him to achieve his full potential."
The Challenged Decision
"15. … [A]t the outset of our discussion, Sue Colliver had about three-quarters of the information that she seemed to need. As I recall, based on that information she told us that she had calculated that [B] should contribute £18.00 per week towards the cost of his care at [C]. [Mr B] and I did not want [B] to have to pay anything and we told Ms Colliver about other things that [B] spends his money on and which we thought she should include in the calculation, including holiday-related costs. This resulted in Sue Colliver re-calculating [B's] contribution as £0. During the meeting Sue Colliver filled in a form setting out the calculation. Before leaving our house, Ms Colliver gave us a copy of the completed form …
16. Until that meeting when Sue Colliver presented us with the financial assessment, [Mr B] and I had no idea that [B] would have to pay anything at all. At the end of the meeting, we understood that [B] would not have to pay anything.
17. So once again, after the meeting everything carried on as normal …"
Clothing | £6.41 |
Home stay | £32.31 |
Water excess | £2.11 |
Carpet cleaning | £1.06 |
Excess fuel | £8.20 |
Gardener | £1.00 |
Window Cleaner | £0.20 |
Beach hut rental | £2.56 |
Reflexology | £15.00 |
Swimming | £10.00 |
Aromatherapy | £7.12 |
Gateway Club/Swimming Membership | £2.69 |
Holiday | £8.72 |
That was all set out in a handwritten table prepared by Ms Colliver. In that table, in respect of each of the DRE items in a column headed "Evidence seen Y/N", Ms Colliver inserted "Y". The sum of that weekly expenditure exceeded B's relevant income (by £5.54). Consequently, there was no sum in his case against which a charge could attach: and the weekly charge was consequently assessed as nil. That calculation was handwritten by Ms Colliver at the meeting, and was countersigned by Mrs B in a declaration that the information provided to Ms Colliver was accurate.
"It was agreed in principle that charges would have to be applied consistently but also to consider a transitional arrangement due to the fact that there had been incorrect financial assessments carried out and that [Supported Living Services] users had come from a system where there had been poor practice in the service provided and where charges were not applicable" (Mr Stephenson Statement, Paragraph 7)".
"…..In the sample that Robin [Stephenson] and I have been through it highlighted that there was a lack of evidence to support some of the DREs and other DREs were also questionable. One of the main issues highlighted was should some of the items be treated as DRE or should they be part of the Care Plan….
….Therefore due to the necessity of gaining evidence, decisions on what should be in the care plan and the potential negativity of this charge, it was proposed that there should be a transitional arrangement. This transitional arrangement would not only help the user but give DASC time to review and make decisions about what should be in the Care Plan and what should not….
Guidance to care managers explaining what should be part of the Care Plan and paid for by DASC would be decided upon by yourself and then passed on to Care Managers once completed…."
(i) The Authority had identified a major problem in the assessment to charging of those service users who had transferred over from the Trust. The levels of assessment were much lower than the levels for those service users who were already being provided similar services by the Authority.
(ii) Two reasons for this discrepancy had been identified by the Authority. First, the assessors had allowed as DRE items which could not fall within that category of expenditure. Second, the assessors had allowed as DRE items which could fall within that category but which were not evidenced as the Authority required from other users. Evidence was lacking in respect of both the identification of expenditure as reasonable DRE, and also quantum (receipts and bills).
(iii) Concern was expressed over the content of the care plans: as to what should fall within the care plan, and what should not.
(iv) In the circumstances, it was proposed that there be transitional arrangements to enable the Authority to do further work on the care plans, and also do further work on ensuring that DRE was properly evidenced.
"You have recently been visited, or very soon will be, by a person from the [DASC]. This person will look at how much you will need to pay towards your support.
Not long ago we met in Adult Social Care to think about how much money you may need to pay towards the cost of your support. You will not need to pay any money at all until October 2008.
We will send you another letter at the end of July to explain how much you will have to pay and how this will work."
"Following our letter of 30 June 2008, this letter is to explain about your contribution towards your care. As you may be aware, under the Government's Fairer Charging policy, all users receiving care that comes under Adult Social Care's responsibility are liable to contribute towards the costs of that care. How much an individual will need to pay, and whether they will have to pay anything at all, is determined by the [DASC], in accordance with Government Guidance.
Individual Financial Assessments
The amount each person contributes is calculated through an Individual Financial Assessment (IFA). An IFA is based on a user's income including benefits minus [DRE]….
In assessing [DRE], the overall aim will be to allow for reasonable expenditure needed for independent living by the disabled person. Items where the user has little or no choice other than to incur the expenditure, in order to maintain independence of life, will normally be allowed. For the most part, assessment interviews, including assessments of [DRE], will be carried out at the user's home.
Your Individual Financial Assessment and interim charging arrangements from 4th October 2008
Your IFA shows that your contribution will be £68.5 per week. This will remain in place until October 2009, unless your circumstances` significantly change.
You may have received a previous assessment. This has been used in conjunction with other information and guidance to reach the amount of your contribution.
A copy of the revised Financial Assessment, showing how this figure has been arrived at, will be sent within the next few weeks.
During the year October 2008-October 2009 we will be reviewing both your Care Plan and actual costs submitted as evidence of [DRE]. Many of the figures that we have used in the current round of IFAs have been based on information provided, and it is hoped that during this year we will have evidence of actual bills, etc.
For the Care Plan we will be talking to carers, advocates etc as to whether certain expenditure is necessary to the sustainability of the user's independence. If so this will be entered into the Care Plan and staff carrying out IFAs will be able to use this information when deciding whether it is [DRE].
Introduction of the full charging regime from 3rd October 2009
During the summer of 2009 there will be a review of the overall position in anticipation of the full contribution coming into force from 3rd October 2009.
Your Care Provider will be asked to collect your contribution as this amount will be deducted from their payments.
If you have any queries about this please contact your social worker in the first instance, or if it is specifically about how the contribution has been calculated please contact Marie Harvey on [telephone number]."
It was signed by Ms Sue Jago, Team Manager, SLS Team.
Home stay | £32.31 |
Carpet cleaning | £1.06 |
Window Cleaner | £0.30 |
Beach hut rental | £2.56 |
Reflexology | £15.00 |
Swimming | £10.00 |
Aromatherapy | £7.12 |
Holiday | £8.72 |
"A number of items could possibly be classed as DREs but no evidence was forthcoming. For example, the evidence could come from a Doctor or other medical practitioner or via the care Plan showing extra costs involved for home stay and why this is necessary for [B] to remain living in the community. Evidence is required not only to show there is a need, but also to prove that money has been spent on the relevant item or service. The following table gives the reasons for not treating the expenditures listed above as DRE.
Item/Service | Reason for not treating as DRE |
Home stay | This would not normally be considered to be a DRE unless there was specific evidence around the necessity. No evidence has been seen as yet. |
Carpet cleaning | Not normally treated as a cost related to disability, but as an everyday expense. |
Window cleaner | As above |
Beach hut | As above. |
Reflexology | As above. However, evidence from a GP or medical practitioner might change this to a DRE. No evidence has been seen as yet. |
Swimming | As above. No evidence seen as yet. |
Aromatherapy | As above. No evidence has been seen as yet. |
Holiday | The cost of a holiday is not a DRE but the cost of a carer/s could be considered as a DRE if there was evidence of need in the care Plan. No evidence has been seen as yet." |
Grounds of Challenge
Ground 1: Legitimate Expectation
Grounds 2 and 3: Failure Properly to Assess Needs, and Error in Construing and Following Relevant Guidance
"As you will see from our [DRE] guidance, holidays and trips out are not specifically mentioned. This is because the Department does not consider either as essential expenditure needed for independent living and is treated as a discretionary purchase."
That is of course a reference to the pre-December 2008 guidance of the Authority, (referred to in Paragraph 15 above). In this letter, Mr Fripp was clearly referring to the additional costs of a holiday as the result of a service user's requirement for a carer (i.e. the costs of a carer's travel, accommodation, food, etc, and a charge relating to that carer's wages), and not the service user's own costs of travel, accommodation, food etc - because he was responding to the letter of 11 September from B's solicitors which made clear that the former were the only holiday costs being claimed.